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Journal and News Scan
Guidance Statement from the Canadian Society of Cardiac Surgeons (CSCS) and its Board of Directors on patient assessment and triage, risk reduction, and real-time sharing of expertise and experiences during the COVID-19 pandemic.
Topical review on the epidemic in Britain, with a number of observations that relate to the cardiothoracic surgeons and all healthcare professionals:
-The assertion that the National Health Service in Britain was overrun PRIOR to the pandemic.
-The assertion that acute angina is now being undertreated.
-Perhaps most worryingly, the assumed increase in non-COVID positive deaths in Scotland.
In the light of the government poised to review the lockdown in an attempt to balance the prevention of another viral infestation versus the conceivable grave financial implications here in the UK and worldwide, it is interesting to see their take on the financial toll on patients.
Prediction of postoperative ventricular dysfunction is performed using preop LVEF prior to mitral valve surgery for degenerative mitral regurgitation. In this study the utility of LV strain as a predictor of ventricular dysfunction after mitral surgery was assessed. Preoperative RV, LV, and LA strain were strongly associated with postoperative LV dysfunction, and may prove useful in timing of surgery for degenerative mitral regurgitation.
The authors present a meta-analysis of randomized controlled trials regarding the outcome of ticagrelor-based antiplatelet therapies in patients after coronary artery bypass graft (CABG) surgery. They found a reduced rate of major adverse cardiac events and a reduced mortality in these patients receiving aspirin and/or clopidogrel. This finding should be investigated in randomized trials, as it could potentially change the standard of care of CABG patients.
The NCDB was queried to assess the optimal timing for resection after induction therapy for IIIA NSCLC. Survival was better in patients who underwent surgery in a short delay interval (<77 days) compared to a long delay (>114 days); short and medium delay intervals had similar outcomes.
This position statement recapitulates the role of the clinical perfusionist in Germany. The needed qualifications to accomplish the complex tasks are described and responsibilities defined. This consensus statement is an important step to emphasize the clinical perfusionist as an important partner for cardiac surgery and cardiology.
In this small series of propensity score matched patients, two methods of administering cardioplegia, each using a different agent, were assessed for outcomes of isolated CABG. A repeated infusion with Basel Microplegia was superior to a single shot of Cardioplexol® for troponin release, creatinine kinase, and ICU stay. Major adverse events did not differ.
Another refreshing change of pace with an interesting pre-translational contibution to the genetics of atrial dysrhythmias.
A tribute to a pioneer and humanitarian in our field, Dr Francis Robicsek.
In the ISCHEMIA Trial, 5179 patients with moderate or severe myocardial ischemia were randomized equally into two groups based on initial management strategy: initial invasive strategy (angiography and revascularization when feasible) and medical therapy, or initial conservative strategy (medical therapy alone and angiography if medical therapy failed). Primary endpoint was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. After a median follow-up of 3.2 years, primary outcome events occurred in 318 of the invasive-strategy group and in 352 of the conservative-strategy group, the respective numbers of death were 145 and 144 in two groups.
These results did not show that an initial invasive strategy of angiography and revascularization reduced the risk of ischemic cardiovascular events or all- cause death over a median of 3.2 years, as compared to an initial conservative strategy.